Provider Demographics
NPI:1609875251
Name:LEVENTHAL, TODD OWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:OWEN
Last Name:LEVENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 CENTRAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1547
Mailing Address - Country:US
Mailing Address - Phone:908-464-4600
Mailing Address - Fax:908-464-4737
Practice Address - Street 1:571 CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:908-464-4600
Practice Address - Fax:908-464-4737
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-16
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66963207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0973728OtherUS HEALTHCARE
NJ7129567-014OtherCIGNA
NJ5349261OtherAETNA
NJ7516801Medicaid
NJ005730ANJOtherINDIVIDUAL PTAN
NJ5715857OtherGHI
NJP2174979OtherOXFORD
NJ7516801Medicaid
NJG29520Medicare UPIN